What is menopause?

The menopause is natural part of aging process in every woman’s life. For most women this process begins around the age of 40, when your menstrual cycle is irregular. The decrease in hormone levels – estrogen and progesterone – is responsible for the changes in menstruation. These hormones are responsible for protecting the health of vagina and uterus, for regular menstrual cycles and to achieve pregnancy. Estrogen is also essential for protecting the health of the bones and maintaining normal cholesterol levels in your blood. There are several surgeries that can lead to menopause. For example, the removal of the uterus (hysterectomy) will make your period stop. When both ovaries are removed (oοphorectomy), menopause symptoms begin immediately, regardless of age.


Hormonal Changes and Menopause

A woman’s body changes throughout her life. Menopause related body changes are almost always triggered by hormone imbalances. The transition period before menopause and the first year after menopause is commonly called perimenopause. Perimenopause, is when most intense menopause symptoms occur, including irregular periods, hot flashes, and night sweats. Usually, perimenopause begins about 2-4 years before the last menstruation cycle and lasts for about 1 year after that. Menopause is defined as the time when a woman has no period for 12 months. Menopause then lasts for the rest of a woman’s life and achieving pregnancy is no longer possible in a natural way. There may be some symptoms, such as vaginal dryness, which may continue during menopause.


What are the signs and symptoms of menopause/menopausal symptoms?

Changes in hormone levels (mainly lack of estrogen and progesterone) can cause several symptoms which are likely to last from a few months to a few years. Some women go through menopause without any complications or unpleasant symptoms, others find menopausal symptoms quite debilitating. If any of these symptoms have a significant impact in your daily life, please contact your doctor. The most common symptoms are:

  • Menstrual changes. This is usually one of the first signs. Your period may start to appear less regularly, you may notice that blood flow decreases or increases, or your period lasts longer. It is possible that the period occurs early, three weeks after your last menstruation or lasts more than one week. You may also notice spotting between periods. Women who have heavy menstrual bleeding and cramps are usually relieved from these symptoms when menopause begins.
  • Hot flashes. During hot flushes occur, you will feel a sudden hot, burning sensation mainly in the face, neck and chest or throughout your body. Red spots can appear on the chest, back, and hands. Intense sweating and then shivering may follow. Flushing can be mild, such as a light-reddening or severe enough to wake up from deep sleep (these hot flashes are called night sweats). Hot flashes have an average duration between 30 seconds and 5 minutes.
  • Problems with the vagina and bladder. The lack of estrogen results in atrophic lesions in the genital and lower urinary tract. The vaginal epithelium becomes progressively thinner, dryness occurs, and vaginal fluids decrease, resulting in pain during sexual intercourse. The pH of the vagina changes and vaginal infections and/or urinary tract infections or cystitis might become more frequent. Another problem that often occurs after menopause is urinary incontinence. Some women experience loss of urine during exercise or running, when they sneeze, laugh or cough, while others find it difficult to hold urine.
  • Sexual intercourse. Some women find that their libido changes with menopause. For many postmenopausal women, sexual intercourse becomes painful because of vaginal dryness. On the other hand, some women feel free and more comfortable after menopause, because contraception is no longer needed. However, even if you do not have menstruation you should continue to use a contraceptive method for a year after you last period (if you want to minimize the possibility of getting pregnant). After menopause there is still a risk of acquiring a sexually transmitted disease, such as HIV/AIDS or gonorrhea, so make sure that your partner uses condom every time you have sex.
  • Sleep problems. There are many women having difficulties to fall asleep – they do not sleep well wake up too early or too easily. They may have to use the toilet in the middle of the night and then having a hard time sleeping again. Some women wake up, many times, because of hot flashes.
  • Mood changes. There may be a link between changes in estrogenic levels and a woman’s mood. Mood swings can also be caused by stress, family changes, such as children leave home, or by feeling exhausted. Depression is not a menopausal symptom but, women are susceptible to depression during menopause.
  • Changes in your body. Some women find that their bodies change during the transitional period of menopause. As women age, muscle mass is lost, adipose tissue increases and the skin losses elasticity and wrinkles. Other women have memory problems or joint pain and muscle stiffness. Regular exercise and healthy nutrition habits can minimize or even prevent these symptoms.

Heart and Bones

During menopause women are prone to lose bone tissue that weakens bones and cause osteoporosis. There is also an increased risk of heart disease due to weight gain, high blood pressure and abnormal cholesterol levels.

The body always replaces the old bone with a new healthy bone. In women with lack of estrogen during menopause, more bone is lost than is replaced. If too much bone mass is lost, the bones become thin and weak and can easily break. Progressively, bone loss occurs in all people with increasing age, but this loss is accelerated in women after the ovaries stop working and this results in postmenopausal osteoporosis. Many people do not know that they have weak bones until a wrist, any bone of the spine or a hip break. Bone Density Measurement is the test you need to do in order to find out if you are at risk of developing osteoporosis. You can reduce the risk of bone loss and the appearance of osteoporosis with appropriate lifestyle changes – exercise regularly by doing weight-based exercises, walking, running, dancing and the daily intake of calcium and vitamin D through proper diet. There are also medications available to prevent bone loss. Always consult your doctor to find out what’s the best for you.

Younger women have a lower risk of developing cardiovascular disease than men of the same age. But after menopause, the risk of developing cardiovascular disease for a woman is almost the same as that of a man.  In fact, heart disease is the leading cause of death in women, killing more women than lung or breast cancer. It is important to check regularly to determine your blood pressure and total cholesterol, HDL, triglycerides and fasting blood glucose levels. You can reduce the risk of heart disease with a healthy diet, smoking cessation, weight loss and regular exercise. There are medications that can help. Talk to your doctor to make sure you do everything possible to protect your heart.

How can I stay healthy during menopause?

To stay healthy, you can make some lifestyle changes, i.e. get new daily habits which contribute to a healthier lifestyle, for example:

  • Quit smoking.
  • Follow a healthy diet that is low in fat and cholesterol. Your diet should include fibers, fruits, vegetables and whole grain food. It should also include vitamins and minerals and calcium.
  • Lose weight if you are overweight.
  • Exercise regularly (walking, running, dancing) at least 3 days per week.
  • Visit your doctor and follow the recommended treatment to lower blood pressure.
  • Treat vaginal dryness using a vaginal water-based lubricant (not petroleum jelly) or an estrogen cream.
  • If you often want to use the toilet, consult your doctor about the appropriate techniques to treat this symptom. Some of these include pelvic muscle exercises, biofeedback, and bladder training. These exercises help you gain better muscle sensation and control.
  • Remember to have all the appropriate examinations regularly. The annual gynecological inspection includes gynecological examination, smear test, clinical examination of the breast by specialist, mammography, bone density measurement and ultrasound. Immediately contact your doctor if you notice a lump in your chest.

If you experience hot flashes, keep a record when they occur. This will give you useful information and help you to determine what causes them. The following techniques will help you deal with these symptoms:

  • When you feel that a flush start, prefer to go to a cool place until you feel cool again.
  • If you wake up often due to hot flashes, choose the coolest room of the house to sleep.
  • Wear dresses especially during summer because you can take them off easily whenever you feel too hot.
  • Prefer sheets and clothing that allow your skin to breathe easily.
  • Drink cold drinks (water or juice) at the beginning of a flush.

What is Hormone Replacement Therapy (HRT)? ;

During perimenopause, your doctor may prescribe a hormone therapy, especially if you experience heavy and often unpredictable menstruation. Medication can also help reduce other perimenopause symptoms such as hot flashes. However, menopausal symptoms may not be immediately noticed because of therapy. If you think you are at menopause, you may stop the treatment for some time and notice if your period comes on a regular basis. During menopause, your doctor may prescribe estrogen and progesterone, known as hormone replacement therapy or HRT. Hormone replacement therapy is a form of hormone therapy used to treat symptoms of menopause by replacing hormones that are no longer produced by the ovaries. For many women after hysterectomy, estrogen treatment is a perfect option, producing satisfactory results. The combination of estrogen and progesterone also helps to reduce the risk of developing uterine cancer. Women who have not undergone hysterectomy should take estrogen together with progesterone to avoid endometrial hyperplasia. The combination of estrogen and progesterone helps reduce the risk of developing uterine cancer. These hormones can be found in the form of pills, skin patches, creams or vaginal tablets, depending on a woman’s needs. Hormone replacement therapy can relieve you from menopausal-related symptoms, such as hot flashes and sweats, while helping to prevent or delay osteoporosis. However, this treatment in addition to its benefits also has risks. It should not be used as a long-term treatment to prevent cardiovascular disease. Hormone replacement therapy decreases the risk of cardiovascular disease. Though it increases the risk of blood clots and breast cancer, while it appears to reduce the risk of colon cancer. Scientists are still studying the effects of hormone therapy, but final answers are not yet available. Always consult your doctor before taking estrogen, progesterone or both or use other treatments (for example, biofeedback) to relieve menopausal symptoms.


What are phytoestrogens?

It is plant-derived estrogen contained in cereals, vegetables, legumes and herbs. They have the same effect as estrogen produced by the body itself, but they are not as effective. Some types of phytoestrogens help lower cholesterol. Soybeans, wild tubers of dioskorea and herbs such as black cohosh and dong quai contain enough phytoestrogens to relieve certain symptoms of menopause. It has been argued that they are not so effective in controlling mild or intense hot flashes, but there are also opposing opinions. Scientists are studying some of these herbal estrogens to determine whether they beneficial and safe. There are soya isoflavones on the market to treat hot flashes, night sweats and vaginal dryness. Consult your doctor and inform him if you decide to include phytoestrogens rich food in your diet. Always be alert to the possibility of unexpected side effects, especially if you take them at high doses or if you take other kind of medication.


How do I decide what to choose?

Discus with your Physician which is the best way to treat the symptoms of climacteric and menopause. Notice which of these symptoms and the extent that affect your daily life. In addition, you should take into consideration your individual medical and family history (the risk of developing hypertension or other cardiovascular diseases, osteoporosis or breast cancer). Remember that whatever decision you make is not final. Discuss your concerns with your Doctor and the results of the treatment should be reviewed along with your annual check-up. For your grandmother and great-grandmother, life expectancy was shorter. Getting to menopause often meant that their lives were coming to an end. But that’s no longer the case. Today women live longer – on average, until the age of 83. If you follow a healthy lifestyle and receive a good treatment, you can enjoy your many years ahead!